The Long and Short of Quality Improvement in Healthcare Or, everything you didn’t want to know about quality improvement, but we think you should. Kendra Jacobsen, M.S. Madison Patient Safety Collaborative January 27th, 2007

MPSC Members

MPSC • Formed in 2000 • Won’t compete on safety • Established structure – – – –

Key medical, administrative and quality improvement leadership from each organization Meet monthly for strategic direction and decision-making Representatives champion MPSC projects at their organizations Multidisciplinary workgroups from each organization meet, design and implement specific initiatives • • •

Nursing Pharmacy Physicians

MPSC Mission •

The Madison Patient Safety Collaborative –

– – –

Provides a structure for area healthcare providers to learn and work collaboratively to develop, share and implement evidencebased patient safety practices; Partners with healthcare researchers to develop new knowledge in patient safety; Shares effective patient safety practices with providers and communities beyond Madison, and Takes an active role in the education of healthcare professional students to ensure their adoption of effective patient safety practices.

MPSC Vision

To make patient healthcare the safest possible

MPSC Projects • • • • • • • • • •

Reducing error-prone abbreviations (2001-2002) Reducing patient falls Falls Aggregate Root Cause Analysis Disclosure of Unanticipated Outcomes and Medical Errors Patient brochure on medication safety Increasing hand hygiene compliance Surgical Infection Prevention (SIP) Medication reconciliation Patient Safety Education Center Share patient health data electronically between organizations

The Next 45 Minutes • • • •

Lecture Conversation Prepare for small group breakouts Air out assumptions

Learning Objectives • Define “quality improvement” (QI) • Define “patient safety” • Become familiar with – QI language – QI tools

• Define “the system” • Develop your eye to identify inefficiencies and waste • Categorize strengths and weaknesses in the system

My background • Step 1: – Some random undergrad degree that doesn’t get you a job

• Step 2: – Better paying job as pharmacy technician at UW Hospital

• Step 3: – Back to school – Industrial and Systems Engineering with a focus in health systems

Quality Improvement • Write down words that would describe the term Quality Improvement

Patient Safety • Write down words that would describe the term Patient Safety

The History of Quality Improvement • Frederick Taylor – “Cheaper by the Dozen” – The Principles of Scientific Management – Efficiency – Manufacturing

• W. Edwards Deming • J. M. Juran • Various other trends – Share basic philosophies

Quality Improvement Methods • • • • • • •

Kaizen Total Quality Management (TQM) PDSA Six Sigma Baldrige Total Quality Model Lean Six Sigma Lean

Kaizen, or 5 S • •

•

• • •

Five Chinese words that describe standardized cleanup: Seiri (整理): tidiness, organization. – Refers to the practice of sorting through all the tools, materials, etc., in the work area and keeping only essential items. Everything else is stored or discarded. This leads to fewer hazards and less clutter to interfere with productive work. Seiton (整頓): orderliness. – Focuses on the need for an orderly workplace. Tools, equipment, and materials must be systematically arranged for the easiest and most efficient access. There must be a place for everything, and everything must be in its place. Seiso (清掃): cleanliness. – Indicates the need to keep the workplace clean as well as neat. Cleaning in Japanese companies is a daily activity. Seiketsu (清潔): standards. – Allows for control and consistency. Everyone knows exactly what his or her responsibilities are. Shitsuke (躾): sustaining discipline. – Refers to maintaining standards and keeping the facility in safe and efficient order day after day, year after year.

Plan, Do, Study, Act (PDSA)

Act

Plan

Study

Do

• PDSA – Also PDCA – Method – Verb

PDSA = SBAR? • • • •

Plan Do Study Act

• • • •

Situation Background Assessment Recommendation

Common Philosophies of any Method • Define the problem • Hypothesize solutions • Define measures of success – “You can’t improve what you can’t measure”

QI Success • Start small • Expand your eye to see the whole picture • Be willing to try something new – Yes, even if you think it really won’t work

QI Toolkit • Diagrams – Fishbone/Cause and Effect – Affinity – Interrelationship – Checksheet – Scatterplots – Histogram

• Flowcharting – Basic – Swim lanes

• Processes – Failure Mode and Effects Analysis (FMEA) – Root Cause Analysis (RCA) – Five Whys – Aggregate RCA

What is “The System?” • Write down words that describe – Systems issues – Systems problems – Systems fault

Work System Technology and Equipment

Adapted from SEIPS System Model

Organization / Department Culture

Person

Processes

Environment

http://www2.fpm.wisc.edu/seips/

SEIPS Model of Work System and Patient Safety

Carayon, P., Hundt, A.S., Karsh, B.-T., Gurses, A.P., Alvarado, C.J., Smith, M. and Brennan, P.F. “Work System Design for Patient Safety: The SEIPS Model” to be published in Quality & Safety in Health Care, 2006.

Web Resources • Deming Institute – http://deming.eng.clemson.edu/pub/tutorials/qctools/homepg.htm

• Free Quality – http://www.freequality.org/

• Brecker Associates – http://www.brecker.com/quality.htm

• Business Balls – http://www.businessballs.com/qualitymanagement.htm

• MoreSteam.com – http://www.moresteam.com/toolbox/